Regional WC Claims Specialist

Selective Insurance Company of America; Charlotte (NC); On-site; USD 60,000 - 78,000; Full time

Benefits offered by this job

Health care plans

Retirement plan with company match

Tuition assistance and reimbursement

20 days paid time off

Job summary

Selective Insurance Company of America is seeking a Workers Comp Claim Rep to handle claims for the South/West Region. You will investigate coverage and compensability, obtain information for thorough investigations, and partner with nurse management to return injured workers to work when possible.

Responsibilities include managing reserves, documenting files, handling both non-litigated and litigated claims, and ensuring regulatory compliance.

Qualifications

• Knowledge of workers compensation statutes, coverage, and case law.
• Excellent written and verbal communication skills.
• Working knowledge of medical treatment and terms as related to medical only workers compensation claims.
• Critical thinking skills to assess compensability of WC claim as it relates to the facts and law.

Responsibilities

• Receives assigned lost time claims for investigation to determine coverage and compensability on claims with a short disability period of 8 weeks or less (could occasionally exceed 8 weeks).
• Processes claims which include making contacts, setting reserves, establishing file in MCS, evaluating exposure, and establishing initial and subsequent reserves on less severe claims with a general exposure of less than $75,000; may handle claims that exceed $75,000.
• Documents claim files and maintains control of work through documentation or diary system.
• Handle non-litigated and litigated claims.
• File state forms timely in accordance with statutory guidelines.
• Collaborate with nurses and vendors on medical and disability management.
• Prepare for and participate in claims review and settlement conferences.
• Ensure compliance with company, state, and federal regulations.

Skills

Statutory knowledge

Communication skills

Medical terminology

Critical thinking

Education

College degree preferred

Job description

Selective Insurance Company of America is seeking a Workers Comp Claim Rep to handle claims for the South/West Region. You will investigate coverage and compensability, obtain information for thorough investigations, and partner with nurse management to return injured workers to work when possible.

Responsibilities include managing reserves, documenting files, handling both non-litigated and litigated claims, and ensuring regulatory compliance.